HOSPITAL ACQUIRED INFECTIONS IN CANADA AND HOW TO STOP THEM MICHAEL HURLEY & JONAH GINDIN, ONTARIO COUNCIL OF HOSPITAL UNIONS (OCHU)

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Poor collection of Hospital Acquired Infection (HAI) data in Canada

10.5% of admissions result in a HAI (Public Health Agency of Canada)

This means:330,000 HAIs in Canada each year12,000-18,000 deaths3rd leading cause of death, after cancer and heart disease

Annual cost to Canadian health system: $1—9 Billion

WHY? OVERCROWDING

Academic literature shows that high occupancy rates increase risks of superbug infection

Specifically, occupancy rates below 82% have been associated with significantly decreased levels of infection

Canada has hospital occupancy rate of 89%, higher than any other Organization of Economic Cooperation and Development (OECD) country

Less hospital beds than any other OECD country, after Mexico.

ONTARIO? WORST PROVINCE

Ontario has less hospital beds than any other province, less than Mexico, about the same number as Haiti (the poorest country in the Western Hemisphere).

When 91 patients died at Joseph Brant Memorial Hospital it was regularly operating at 105% capacity

WHY? CUTS TO CLEANING

Academic literature shows that:

Superbugs can survive in hospital environment

Can be transferred from environment to hands

Exposure to contaminated environment is associated with colonization

Environment cleaning can reduce risk of infection

Yet governments and hospitals look to cleaning for cost-savings

“Just because it’s a public healthcare system doesn’t

mean that we…should expect to pay more to sweep the floor

in a hospital.”

When there’s an outbreak, hospitals end up hiring more cleaners (after the fact):

Honoré Mercier, QC: 16 deaths. Hospital hired ten additional cleaners to control outbreak

Nanaimo General Regional Hospital, BC: 8 deaths, hospital tried to get out of contract with private cleaning firm Compass due to negligence, but was contractually unable

Niagara Health System, ON: 16 deaths, NHS cut ties with private cleaning firm Aramark after allegations they cut staff and cleaning supplies resulting in outbreak

Burnaby Hospital, BC: 84 deaths, hospital department heads wrote open letter to government demanding enhanced cleaning to stop outbreaks

From 2000 to 2009 the proportion of hospital budgets going to cleaning dropped by 25%

2000 2001 2002 2003 2004 2005 2006 2007 2008 20090.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%Housekeeping as a proportion of total hospital

budget

Housekeeping as a proportion of total hospital budget

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

-15.00%

-10.00%

-5.00%

0.00%

5.00%

10.00%

15.00%

Annual % Increase in Hospital and Houseekeping Fund-ing

Hospital Funding Housekeeping Funding

Erratic increases and cuts to cleaning reflect attempts to cut costs, only to have to reinvest after outbreaks or other cleaning needs’ spike.

B.C. government legislates contracting-out of hospital cleaners in 2003, proportion of cleaning budgets diverted to private contracts has jumped from 3% to 60% since 2003

Privatization nearly halved wages for BC hospital cleaners, rolling them back to pre-1968 levels

Those working for private contractors are now the lowest paid health services support workers in all of Canada, earning 26 per cent below the national average.

One study of contract cleaners found 75% were understaffed, 1/3 did work without training, were limited to only one pair of gloves per shift

Cleaning is a labour-intensive job: staff account for about 93% of cleaning budgets, so when cleaning budgets are cut it translates directly into fewer cleaning hours

In 2004-05 rates of MRSA doubled in B.C./Alberta

Since 2008, B.C. has highest rate of C.diff in country

After a 2008 outbreak at Nanaimo General Regional Hospital BC Centre for Disease Control conducted an investigation

They found that private cleaning company Compass Group failed to:

Provide adquate training to cleaners

Sufficient cleaners to meet agreed standards in their contract

Sufficient cleaners to meet needs during outbreak

Poor training and limited cleaning supplies resulted in cleaners over-diluting bleach (1:1000 bleach to water, instead of 1:10), which was determined to have contributed to the outbreak

WHO DOES IT BETTER? NETHERLANDS

“Search & Destroy” strategy involving screening, cohorting and intensive disinfection has kept MRSA infections very low in Netherlands

“Search & Destroy” is also cheaper even though it is labour intensive (because prevented infections save health system $millions)

At only 64%, Netherlands has one of lowest hospital occupancy rates in OECD

WHO DOES IT BETTER? SCOTLAND

Health ministry bringing all hospital cleaning back in-house

Added 1,000 extra cleaners

Have added staff and have involved them in infection-control

Strategy has reduced C.diff 37% in patients over 65, and 42% in those under 65

SO, WHAT IS OCHU DOING ABOUT IT?!